NEEDLESCOPIC ADRENALECTOMY - THE INITIAL SERIES - COMPARISON WITH CONVENTIONAL LAPAROSCOPIC ADRENALECTOMY

Objectives. To report the initial series of needlescopic transperitone al adrenalectomy and to compare the results with a contemporary series of conventional transperitoneal laparoscopic adrenalectomy performed at the same institution.Methods. Fifteen patients underwent needlescop ic adrenalectomy over a 4-month period. Outcome data were retrospectiv ely compared with 21 conventional laparoscopic adrenalectomies perform ed over the preceding 12-month period at the same institution. The nee dlescopic technique included three subcostal ports (two, 2 mm; one, 5 mm) and one umbilical port for ultimate specimen extraction (10/12 mm) . The laparoscopic technique included four subcostal ports (all 10/12 mm). Endoscopic transperitoneal adrenalectomy was completed by the sta ndard technique in both groups. Results. Baseline demographics were co mparable between the needlescopic (n = 15) and laparoscopic (n = 21) g roups. The needlescopic group had a shorter surgical time (169 versus 220 minutes, P = 0.05), less blood loss (61 versus 183 mL, P = 0.002), and shorter hospital stay (1.1 versus 2.7 days, P < 0.001). Convalesc ence averaged 2.1 weeks in the needlescopic group and 3.1 weeks in the laparoscopic group (P < 0.001). No significant complications occurred in either group. One patient in the needlescopic group was converted to conventional laparoscopy because of marked obesity; hospital stay i n this patient was 2 days.Conclusions. Reported herein is the initial series of needlescopic adrenalectomy. Compared with conventional lapar oscopy, needlescopic adrenalectomy results in an overnight hospital st ay, rapid recovery, and excellent cosmesis. However, prior experience with conventional laparoscopy is essential before embarking on needles copic surgery. UROLOGY 52: 180-186, 1998. (C) 1998, Elsevier Science I nc. All rights reserved.